Communication in Nursing:

Avoiding a Failure to Communicate

When it comes to communication in nursing or if your a health care professional, then hopefully you will never be heard saying something like...

I told them
I told them but they would not listen
I told them but they would not comply
or my favorite to hate...I told you so

Did You Tell or Communicate?

Outside of the inconsiderateness and lack of compassion for human failing, the act of telling someone something is not communicating. Communication is complicated. Communication in nursing is even more complicated.

The traditional definition of communication is the imparting (making information known) or exchanging of information or news. It involves two or more people. There is a sender, a receiver and a message. This is the basic communication theory we learned as far back as high school.

What if the theory was incomplete? What if that definition was inadequate?

What is involved in making something known? Does it not require the receiver to not only to hear and accept it, but to process it and be able to respond to the information. How would you know unless there was feedback.

Communication in Nursing: A Theory

The definition of effective nursing communication would need to be more comprehensive.

Communication is the imparting or exchange of information in such a way that the receiver can understand and act on that information and provide feed back that the message received is the message intended.

What Do You Mean, Communication in Nursing?

There is more. Consider how what we say is taken or mistaken. Miscommunication can be divided into the following areas...

What we say

What we think we say

What we really said

What we meant

What the receiver heard

What the receiver thought we said

What the receiver thought we meant

Communication in Nursing: A true story

A patient was declining, an elderly man that was sub-assigned to me. As a LPN at that time, I told my charge nurse who contacted the family.

With no improvement, the decision was to move the patient to the ICU. The ICU was, incidentally, just down the hall.

The charge nurse told me to not to discuss the patient with the family. This may have been because the relative was a friend of the charge nurse. Regardless, any conversation was to go to the charge nurse.

When the relative arrived, a short time after the call, I ran into her as she was coming out of the patients empty room. By ran into, I mean I almost literally ran into her. Upset and understandably so, she asked where her father was.

I said, "He is down the hall, in the ICU." Explaining that the charge nurse will answer her questions, I directed the upset relative in the direction of the other nurse.

Then a somewhat upset charge nurse came up to me asking why I had not told her that the patient had fallen.

"But he did not fall." I exclaimed. Then she asked why I would have told the daughter that he fell.

This was a good example of failure of communication in nursing.

In this instance, it was effectively communicated that the patient was in the ICU. The miscommunication was how he got there. He's down the hall sounded like he had a fall. In effect, there was a failure to communicate even though there was a sharing of information, a message and a receiver, the various emotions that prevented the message from being processed.

If the whole communication theory is not muddied up enough, there is more. We need to speak in such a way so as to get past the spam filters in our brains.

Communication in Nursing: Getting Past the Spam Filters

I conducted a study, looking at the sociological make up of two different groups of people in the State of Pennsylvania, USA. The study took place in Scranton PA and Harrisburg, PA with a distance of about two hours drive time separating the two.

When greeted by anyone with the greeting, "How ya doing," the response was always, Fantastic, but I'm getting better.

In Harrisburg, I spoke to a total of 99 people. In Scranton, I spoke to a total of 89 people. The results show the importance of speaking in such a way as to get past the cultural spam filters of the minds of those we speak to.

In Harrisburg, all but one of the respondents said something in the nature of ... wow, how can you do any better than fantastic. Some would even say that they wanted what ever I had to drink that morning.

The one who did not respond that way expressed their sorrow at not knowing I was not doing well.

The polar opposite happened in Scranton. All but one said that they did not know anything was wrong, that I had been sick or some sort of consolation. Their spam filters, the cultural background / mindnset and other factors caused them only to hear, "...but I am getting better."

Was there communication?

Note: The most heart warming thing that came from this study was that the one who truly listened to the words of the Scranton group turned out to be a nurse. It is wonderful to work with people who, as a class, tend to be great listeners.

The definition of effective communication now expands to....
Communication is the imparting or exchange of information in such a way that the receiver can understand without preconception and act on that information and provide feed back that the message received is the message intended.

It Will Just Take a Moment More

I am a master of poor timing. However, there are circumstances when there will never be a good time. We are faced with having to wait till there is a better time or we have to manipulate the time. Non-verbal communication can help with this.

At the end of my shift, as I was leaving one night I remembered something I had to do before leaving. It was a patient on a different floor from where I was working asking to see me. Running up to see her, she indicated she was going to be leaving.

Those were her exact words, but she was not talking about being discharged. Rather, she was talking about being transferred to the ECU or as the nuns in the hospital where I worked would call it, the Eternal Care Unit. I did not believe her although when a patient says that now, I always give them the benefit of the doubt. People tend to know when they are going to die.

The off going shift and on coming shift were in report. I did not belong here other than to visit a patient who had requested me.

Turns out she really was dying. She had a massive internal bleed and her blood pressure was dropping.

The daughter, across the bed from me, became hysterical. I did not have time for her to be hysterical. Did you know there is actually a study of communication and time?

Taking charge of the time, the daughter was given two options. Pull it together or leave. Then explaining why she was needed, she indeed pulled it together. At once she started to talk soothingly to keep mom consciously fighting to stay alive.

Her blood pressure had dropped to where most of us would pass out. Actually, her blood pressure had dropped to a point where it was not compatible with life, or so I thought. This was confirmed by the nurse who took over. She, like me, had to check it twice because she could not believe it either.

You can read This I Believe Why Some Patients Refuse to Die. This is my personal experience with communication in nursing when it saved a life.

So communication involves timing. But I did not have time. I did not even have minutes.

That, by the way was not my first code. It was the first and perhaps the last code called on a conscious person. The lesson it taught was that it is possible to take charge of the timing. Whether we choose the right time or have to make the time, the definition of effective communication would include.....

Communication is the imparting or exchange of information in such a way and at such a time that the receiver can understand, provide feed back that the message received is the message intended, and act on that information.

The last patient illustrates the complexity of communication in nursing.

My patient had maybe 6-12 hours before he would be transferred to the Eternal Care Unit. Although in a nursing facility, he was on hospice care. I was the case manager. The family had come in to be with him.

The wife, a petite woman, would barely speak in a whisper. The gentlemen who was her husband and my patient was seemingly comatose. His chart indicated a history of being hard of hearing.

Placing listening part of a stethoscope in his ears and giving the bell part of the stethoscope to the wife, she was encouraged to tell him she was there. She told him she loved him and she will always be here for him.

Then she told him that it was OK. "It is OK to go. I will be fine. The kids will be fine. It is OK to go.

Was this communication? What do you think?

Well, on completing those words, he scrunched his closed eyelids. Communication in nursing is sometimes non-verbal communication. Sometimes it is facilitating communication.

You cannot imagine the joy that last singular communication meant for that wife and the grown children standing around this almost lifeless body.

She was able to impart her love, emotions and acceptance of the situation in such a way that her dying husband could understand and act on that information, providing feed back that the message received is the message intended and it was accepted.

She indeed communicated.

Incidentally, when the family left to allow us to provide care for the patient, on asking if he could hear, he squeezed his closed eyelids again. Then, a few minutes later, in the peace that was within the room, he passed away.

By following the elements of the theory, you will improve your communication in nursing.

More importantly, you will avoid the failure to communicate. There is so much more involved with communicating in nursing. There will be more in the future.